20 N. Wacker Dr., Suite 3118, Chicago, IL 60606 Phone: 312 214 1521

VNA Foundation

Twelve Month Report #3

(for use by multiyear grant award recipients seeking subsequent year funding)

Complete the following information in Microsoft Word Document format. Attach to an email and send it to:

  1. Please give a brief overview of the program funded by this grant.
  2. Please state your outcome measures as written in your original proposal and address your progress toward achieving each. If any outcome measures were changed, please explain why. If you were unable to accomplish certain outcome measures, what hindered the progress?
  3. What internal or external challenges have you faced in connection with this project so far and how did you address these challenges?  Have you made changes to the project (other than what you may have addressed in #2) or has anything changed within your organization as a result? Do you anticipate challenges with this project in the coming year?
  4. What were the most important lessons learned from this project so far? For example, what do you think you have done particularly well and what would you have done differently?
  5. Attach a financial report specific to your grant funds that have been expended so far, using the same format as the budget in your original proposal.
  6. Has your organization or the project for which you request funding experienced any of the following since your last grant with VNA?
    • Changes or turnover in management, board or staffing?
    • Changes to tax exempt status or material changes to financial position?
    • Changes to the direction or mission of agency or project?

    If yes, please explain the changes and attach appropriate documentation of the changes (e.g. board list, budgets, funding sources) to your 12 month report.

    If not, please simply include the following sentence at the end of your report: 

      “(Name of agency) and the project funded per grant #(##-##) have not experienced any material changes in the past year.”

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20 N. Wacker Dr., Suite 3118
Chicago, IL 60606
Phone: 312/214-1521
Fax: 312/214-1529